title: Increased frequency of no-shows in residents' primary care clinic is associated with more visits to the emergency department.
abstract: The high prevalence of no-shows in residents' primary care clinic acts as a barrier to continuity of care, results in loss of outpatient learning opportunities, and may result in more emergency department (ED) visits. The authors seek to identify if high rates of no-shows correlate with more ED visits. In a selected primary care internal medicine (PCIM) continuity clinic, 650 patients were randomly selected, with 325 patients each from the faculty and resident practices. The number of ED visits between January 1, 2006, and December 30, 2008, was recorded. Demographic characteristics of the population were obtained, and comparisons between the faculty and resident groups were performed using Student t test. Linear multiple regression analysis was performed to compare frequency of ED visits between the faculty and the resident groups, controlling for age, interpreter requirement, number of ED visits, proportion of no-shows, and insurance type. A P value <.05 was considered statistically significant. During 2006-2008, the average number of ED visits per patient in the faculty's practice was 2.1 compared with 4.1 in the resident's practice (P < .001). A multiple linear regression model showed that patients who had more ED visits were likely to be younger (P = .004), had shorter duration of care in the PCIM clinic (P < .001), and had a higher proportion of no-shows to the PCIM clinic (P < .001). There was no statistical difference between faculty and resident practice after adjusting for the above-mentioned variables. Shorter duration in the PCIM clinic and higher proportion of missed appointments were associated with more ED visits, but the use of interpreters and Medicaid insurance did not result in more ED visits. Future interventions are necessary to reduce the no-show rate in the clinic as this may result in a reduction of ED visits.
authors.affiliation: Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Nguyen
authors.forename: Ramona S
authors.initials: RS
authors.lastname: Dejesus
keywords: health outcomes; impact evaluation; primary care; progam evaluation